Illuminated highway sign with the words Long Covid and an arrow pointing forward
Previously I wrote that Paxlovid is underprescribed for the treatment of acute Covid in patients at high risk of serious illness. The FDA granted an emergency use authorization based on data showing that “Paxlovid significantly reduced the number of people with Covid-19 related hospitalization or death” by 88% compared to placebo.
In unvaccinated people, Paxlovid was also linked to a 26% lower risk of long Covid-19 in a study by Ziyad Al-Aly.
The data on Paxlovid for that previously vaccinated is mixed. A smaller study from the University of California San Francisco found no benefit in people who had been previously vaccinated.
Another one Pfizer study was published in the New England Journal of Medicine in April 2024. Of the 1,288 patients divided between those who were vaccinated and those who were not, there was no reduction in symptom duration and little difference in the number of hospital admissions.
Paxlovid comes with a number of side effects, most notably nausea, diarrhea and a metallic taste – and most importantly its cost, up to $1561 for a five day course, according to GoodRx. It also comes with a host of contraindications. Note: If you have Medicare, Paxlovid should be covered. Same if you are a veteran or on Medicaid. If you have a co-pay or are uninsured, you may be able to get coverage through Pfizer’s Patient Access Program by visiting paxlovid.iassist.com or call 877-219-7225. This program ends on December 31, 2024. But this requires filling out forms online and energy that you may not have if you are acutely ill. It will also likely result in a delay in getting treatment. Paxlovid is more effective if given early in the course of the disease.
Metformin
Metformin, on the other hand, is of growing importance in the treatment of COVID-19 and especially in the prevention of long Covid-19.
Firstly, laundry Carolyn Bramante’s study in The Lancet last year. When metformin was started within the first three days of illness and continued for 14 days, her study showed a 41% reduction in the incidence of long-term Covid-19, with an absolute reduction of 4.1%, compared with placebo when it was started.
In a May 2024 study (COVID-OUT), Bramante’s group showed the SARS-CoV-2 The viral load was reduced 3.6-fold with metformin compared to placebo. The viral rebound from day 5 to day 10 was also significantly reduced. When metformin was started less than four days after the onset of symptoms, it reduced the risk of severe COVID-19 by 55% and of long-term COVID-19 by 65%. This study was conducted in a standard-risk population: over 30 years of age, overweight, and not requiring hospitalization.
The latest news supporting the use of metformin comes from the NIH-funded Research on the COVID to Enhance Recovery Initiative (NIH RECOVER).. Most of the 1,300 patients in Bramante’s 2023 Lancet article were obese or overweight but did not have diabetes. This study looked specifically at patients who already had diabetes, comparing the electronic health records of 75,996 adults who were already taking metformin with 13,336 records of patients who were taking other types of medications for their diabetes. They found that patients taking metformin had a 13% to 21% lower incidence of long-term COVID or death.
In addition to lowering blood sugar levels, metformin reduces viral load and pro-inflammatory molecules that contribute to clotting.
Metformin is not a miracle cure, but we are increasingly learning about its benefits. anti-aging and anti-inflammatory effects. Side effects are mainly gastrointestinal complaints: nausea or diarrhea, and the drug is better tolerated if it is increased. It is relatively cheap, $10-30 for a 60 day dose, 500 mgAnd rarely has serious side effects.
I believe that all adults with acute COVID-19 should receive at least metformin. This has left me frustrated in my training with community groups and my free every week COVID-19 newsletterI have recommended that acutely ill, high-risk people ask their doctor for an antiviral drug and metformin. Yet my friends tell me that their doctor or nurse has denied their specific request to prescribe both medications. Even after getting the data, some doctors deny the request for a two-week course of metformin because “it’s only for diabetes.”
With increasing evidence of metformin’s benefit and the enormous toll of the long Covid-19 period, we will hopefully see wider uptake of metformin.